CMS proposes 'site-neutral' payments for outpatient, hospital clinic visits

2018 02 14 21 21 4230 United States Flag 400

Healthcare providers would be paid the same by Medicare for clinic visits regardless of whether the service took place in a hospital or an outpatient setting under a proposal for site-neutral payments issued July 25 by the U.S. Centers for Medicare and Medicaid Services (CMS).

The proposal would overturn a longstanding Medicare policy in which healthcare payments vary based on the setting in which they occurred. CMS released the site-neutral proposal as part of proposed changes to its 2019 Medicare Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Center (ASC) payment system.

CMS noted that Medicare often pays more for clinic visits -- basically checkups with clinicians -- if they occur in the hospital setting as opposed to physician offices. But under site-neutral payments, the payment would be the same.

This change would result in lower co-payments for beneficiaries and increased savings for the Medicare program, and it is being proposed under CMS' authority "to control unnecessary increases in the volume of covered hospital outpatient department services."

"For an individual Medicare beneficiary, current Medicare payment for the clinic visit is approximately $116, with $23 being the average beneficiary co-payment," CMS said. "The proposal to adjust this payment to the physician fee schedule equivalent rate would reduce the OPPS payment rate for the clinic visit by ... 40% to an amount of $46 and a beneficiary co-payment of $9."

The proposal is estimated to save Medicare $760 million and save patients $150 million in lower co-payments.

As for ambulatory surgical center payments, CMS is suggesting to update these rates by 2%, in hopes that this change will "help to promote site-neutrality between hospitals and ASCs and encourage the migration of services from the hospital setting to the lower cost ambulatory surgical center setting."

The rule would also reduce by 15 the number of measures ambulatory surgical centers and hospital outpatient departments are required to report under Medicare's program to promote quality in healthcare, according to CMS.

"The proposed removals are aimed at enabling providers to focus on tracking and reporting the measures that are most impactful on patient care," the agency said.

The deadline for submitting comments to the proposed rule is September 24.

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